距下关节稳定术治疗儿童柔韧性平足症的疗效分析  

Clinical outcomes of extraosseous talotarsal stabilization in treatment of flexible flatfoot in children

作　　者：程翔宇[1] 宋卫东[1] 刘浩宗 

机构地区：[1]中山大学孙逸仙纪念医院骨科,广州510120 [2]台山市人民医院骨科,529200

出　　处：《中华关节外科杂志（电子版）》2016年第1期40-44,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的评价距下关节稳定术（EOTTS）治疗儿童柔韧性平足症的初期疗效,并探讨EOTTS对后足稳定性的影响。方法 2014年4月至2015年4月,中山大学孙逸仙纪念医院骨科对14例（22足）儿童柔韧性平足症患者[平均年龄（11±2）岁]应用Hy Pro Cure施行EOTTS治疗,术后定期随访患者的一般情况、外观、功能及影像学表现,对完整随访资料进行前后对比分析。结果本研究患者均获得完整随访,平均随访时间（13±4）个月（范围6-18个月）。无难以处理的并发症发生,无1例出现植入物移除。与术前资料相比,术后视觉模拟评分（VAS）平均减少2.6分,手术前后的差异有统计学意义（t=12.9,P〈0.05）;术后美国足踝外科协会（AOFAS）踝与后足功能评分平均提高33.8分,手术前后的差异有统计学意义（t=11.5,P〈0.05）;术后影像学发现距骨舟骨角减少了67.6%,距骨跟骨角减少了24.1%,跟骨倾斜角增加了34.4%,内侧纵弓高度增加了62.1%,距骨第一跖骨角减少了57.9%,距骨第二跖骨角减少了43.4%,距舟覆盖角减少了58.3%,手术前后的差异有统计学意义（P〈0.05）。结论 EOTTS可有效治疗儿童柔韧性平足症,完善的术前检查对于治疗效果有重要意义,同时EOTTS的关键作用在于稳定距下关节运动轴心,恢复后足正常生物力学。Objective To evaluate the early clinical outcomes of extraosseous talotarsal stabilization（ EOTTS） in treatment of flexible flatfoot in children and to investigate the effects of EOTTS on hindfoot stability. Methods From April 2014 to April 2015,a total of 14 cases（ mean age 11 ± 2 years）with 22 feet of flexible flatfoot underwent EOTTS by the Hy Pro Cure devices at the Department of Orthopedics of Sun Yat-sen Memorial Hospital of Sun Yat-sen University. General condition,appearances,function and radiological performance of the patients were regularly followed and the complete data were compared and analyzed. Results All of the patients were followed with a mean time of（ 13 ± 4） months（ range from six to 18 months）. No severe complications occurred. No implant removal occurred.Compared with the preoperative data,the postoperative visual analogue scale reduced by 2. 6 points on average,the difference before and after the surgery was statistically significant（ t = 12. 9,P〈0. 05）; the postoperative American Orthopeadic Foot Ankle Society（ AOFAS） ankle-hindfoot scores（ AOFAS）increased by 33. 8 points on average,the difference before and after the surgery was statistically significant（ t = 11. 5,P〈0. 05）. The postoperative X-ray images manifested that Meary＇s angle reduced by 67. 6%,talocalcaneal angle reduced by 24. 1%,calcaneal pitch angle increased by 34. 4%,medial longitudinal arch height increased by 62. 1%,talar 1stmetatarsal angle reduced by 57. 9%,talar 2ndmetatarsal angle reduced by 43. 4%,talonavicular coverage angle reduced by 58. 3%; the differences before and after the surgery were statistically significant（ P〈0. 05）. Conclusions EOTTS can be effective in the treatment for flexible flatfoot of children. A perfect preoperative examination is very important for the curative effect. The key role of EOTTS is to stabilize the axis of talotarsal joint motion and thus restore the normal biomechanics of hindfoot.

关 键 词：儿童 扁平足 距下关节 治疗结果 

分 类 号：R726.8[医药卫生—儿科]